NPIMap

Organization Active NPI

Sacred Dental

  • Dentist
  • Conyers, GA
National Provider Identifier
1932461860
Registry record updated Jun 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN013176 Issued in GA
Legal business name
SACRED DENTAL
Practice address
1360 Dogwood Drive
Conyers, GA 30013
Phone
(770) 474-9202
NPI assigned
Jun 15, 2012
Last updated
Jun 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Agatha NwizuNPI 1033220496
Title
Dentist
Phone
(770) 474-9202

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN013176 GA Primary

Addresses

Primary practice location

1360 Dogwood Drive
Conyers, GA 30013

Mailing address

1360 Dogwood Dr SE
Conyers, GA 30013-5075
Phone (770) 474-9202

National Provider Directory

National Provider Directory

Locations

1360 Dogwood Dr SE
Conyers, GA 30013
Phone (770) 474-9202

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339718400000",
    "number": "1932461860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 DOGWOOD DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135075",
            "telephone_number": "770-474-9202",
            "fax_number": "770-474-9842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 DOGWOOD DRIVE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "30013",
            "telephone_number": "770-474-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-15",
        "last_updated": "2012-06-15",
        "status": "A",
        "authorized_official_last_name": "NWIZU",
        "authorized_official_first_name": "AGATHA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "770-474-9202",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.